Revamping Authorizations and Accelerating RPM Adoption
In this quarter’s LTC Provider’s Playbook, we’re looking beyond the short-term market and seeing what’s setting the tone for advances in long-term care that will ease challenges and improve our industry. At the top of our list are two key areas: authorizations and the adoption of technology.
Table of Contents
The Future of Prior Authorizations
The Centers for Medicaid and Medicare Services (CMS) released a proposal that would mandate an electronic prior authorization system for Medicare Advantage, state Medicaid agencies, and Affordable Care Act (ACA) plans.
This proposal comes after long-standing grievances from providers across the healthcare industry around the delays and denials caused by lengthy authorization processes. Many have rightly pointed out how such denials impact patient care in a number of ways, including patients forgoing care due to unnecessary delays in getting the care they want authorized by their care plans.
Adding to existing complications, payers maintain different standards for authorizing care and no standardized system exists to streamline the workflow. This proposal could potentially fix that, bringing an electronic approval system to a range of payers covering millions of Americans. This would enable providers to deliver the care their patients want sooner and with less friction.
AHCA estimates savings of ~$437M with electronic authorization rolled out across the healthcare landscape
There are benefits to a standardized, electronic approval system that extends beyond patient care. The workload related to authorizations for back office and clinical staff can be eased almost overnight once this system comes online. While the new authorizations system won’t go into effect until 2026, it will be a welcome proof of concept that is needed to bring industry-wide change to authorizations and streamline care delivery.
Live Data, Remote Monitoring, Improving Care
In today’s long-term care industry, modern operators are proving to be technologically sophisticated providers. Increasingly, these operators are advancing their facilities’ offerings by upgrading to advanced health tech more commonly seen in hospital systems with far greater funding.
The increasing adoption of remote patient monitoring (RPM) devices in skilled nursing show a commitment to improving care outcomes and assisting clinical staff. Additionally, CMS have robust billing guidelines in place for providers that make clear the incentives to adopt this technology more widely.
A multitude of studies over several years has shown the efficacy of RPM in preventing hospitalizations while newer solutions give clinical staff access to real-time data from anywhere, allowing them to keep a closer eye on the status of residents.
Reducing Hospitalizations with Remote Patient Monitoring
RPM used in a Harvard Medical School study of over 7,000 patients:
- 86% reduction in Code Blue events
- 45% reduction in ICU stays for patients transferred from surgeries
- 9% reduction in length of stays
Additional studies have shown that RPM has the potential to reduce hospital readmissions for heart failure patients by as much as 627,000 incidents per year.
We expect ongoing development of RPM devices that help deliver quality care, which can provide more detailed information than wearables, and require less input from their users (such as charging or remembering to wear the device), especially in the skilled nursing setting.
As more advanced solutions come to market, the adoption of effective devices will follow, allowing providers to gain more granular insights into their residents’ health from anywhere and track trends by analyzing larger data sets. What could follow is a modern approach to preventative care in the long-term care setting that can reduce hospitalizations, improve quality, and aid clinical staff.